title: Hematogenous osteoarticular infections of the hand and the wrist in children with sickle cell anemia: preliminary report.
abstract: BACKGROUND
  Hematogenous osteoarticular infections of the hand and the wrist in children with sickle cell anemia are rare and no specific studies for this location have been published.
  
  
  METHODS
  This retrospective and comparative study reviewed 34 children who carry the diagnosis of osteoarticular infections of the wrist and the hand at our institution during a 10-year period extending from January 2000 to December 2010. The first group included 8 patients with sickle cell anemia (Hg SS). The second group or control group included 26 children without sickle cell disease or any immune deficiency. Differences between groups were established by χ tests.
  
  
  RESULTS
  The most common site of osteomyelitis for the sickle cell group was the metacarpals and the fingers phalanx (87.5%) whereas the most common site for the control group was the wrist and the carpus (96.2%; P<0.005).The most common pathogens responsible for osteomyelitis was Salmonella sp. (37.5%) for children with SCD, whereas it was Staphylococcus aureus (70%) for the nonsicklers. There was a significant difference between both groups regarding the treatment. Indeed, a surgical procedure was needed for the sickle cell group in all cases (100%) whereas a surgical debridement was needed in only 19.2% patients in the control group (P<0.001). At long-term follow-up, there were more long-term complications in the sickle cell group (62.5%) with epiphysiodesis of the metacarpals and metacarpophalangeal joint destruction whereas only 11.5% cases with complications were present in the control group including distal ulna epiphysiodesis, proximal interphalangeal joint stiffness, and a central radius epiphysiodesis (P<0.004).
  
  
  CONCLUSIONS
  Our results confirm the severity of hand osteomyelitis in patients with sickle cell disease. A systematic approach is needed to perform early diagnosis and treatment. Identification of the causative organism is required (blood culture, bone aspiration). With antibiotic therapy, surgical treatment is the rule. Parents have to be advised about frequent complications like shortening or deformation due to premature fusion.
  
  
  METHODS
  Level III.
authors.affiliation: *Orthopaedic Department, Georges-Pompidou European Hospital (HEGP) †Department of Paediatrics, Reference Centre for Sickle Cell Disease ‡Orthopaedic Department, Robert Debre Hospital §Orthopaedic Department, Trousseau Hospital, Paris 6 University, Paris, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Tordjman
authors.forename: Laurent
authors.initials: L
authors.lastname: Holvoet
authors.forename: Malika
authors.initials: M
authors.lastname: Benkerrou
authors.forename: Brice
authors.initials: B
authors.lastname: Ilharreborde
authors.forename: Keyvan
authors.initials: K
authors.lastname: Mazda
authors.forename: Georges F
authors.initials: GF
authors.lastname: Penneçot
authors.forename: Frank
authors.initials: F
authors.lastname: Fitoussi
mesh_terms: D017677:Age Distribution; D000755:Anemia, Sickle Cell / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D050823:Hand Joints / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy*; D011859:Radiography; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016896:Treatment Outcome; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000503:physiopathology
chemical_list: D000900:Anti-Bacterial Agents